3rd and 4th year clerkships

For some reason I had the impression that in your 3rd and 4th year clerkships you would be bouncing all over the place (different hospitals / clinics in different cities). This would give you the opportunity to see sites where you might like to do your residency.

However, I am getting the impressions from the schools (DO) I have interviewed at / am interviewing at, that the the clerkships (particularly 3rd year) are in one geographic location, but you will likely move around a bit (different clinical settings).

After that you select your residency locations (generally having not worked there) and it is based primarily on your scores (in the clerkships and on the COMLEX/USMLE).

Would some of you who have gone through this or are going through this comment on your clerkship years for me and how that relates to residency selection? Have I got the process generally correct?



Required 3d year clerkships and 4th year subinternships are done at hospitals and clinics affiliated with your medical school, and whose attendings are professors at your medical school. You can travel around the country for electives if you choose, and different schools have varying requirements on getting credit for these experiences.

At WVSOM the required clerkships are at “statewide campus” sites with doctors affiliated with the school. They try to keep you to a general geographic region to cut down on living expense as most sites don’t have established housing.

There are 5 choices for sites and a “site selection” lottery - most of the students get their first choice and a small number have to go with their second choice.

There is one “tri-state campus” that has you between WV, Michagan, and Ohio. Also, there is one that is scattered across much of Va as well as into eastern WV, so the sites are not all that close.

Even if you are in one “area” geographically, that could encompass different facilities - a mix of regional medical centers, academic, and small community hospitals and clinics.

4th year, electives can be scheduled anywhere you are interested in and the office of graduate education helps you line up those rotations according to your interests.


At most schools, 3rd year is composed of required clerkships that everyone has to complete. The clerkships that are required at all medical schools are OB, pediatrics, surgery, family medicine, internal medicine and psych/neuro. Schools have different ways in which they approach these. Typically, each of the above is at least 4 weeks, sometimes up to 12 weeks. At my school, all of the clerkships were 8 weeks except for OB/gyn (6.5 weeks) and neuro/psych (4 weeks each). The clerkships may be further divided into smaller blocks - my school tried have everyone do a general and specialty month in both surgery and internal medicine and an inpatient and outpatient month for pediatrics. Depending on your school there are HUGE varieties of rotations that you can take that will fulfill your school’s requirements. Typically, you will have an exam at the end of each core clerkship, many schools use the “Shelf” exam provided by the National Board of Medical Examiners. As Matt mentioned, these clerkships can be at any number of hospitals/clinics that your medical school has relationships with. As you are interviewing at medical schools, this can actually be something to ask about - are most required clerkships in the same city as the medical school, or do they require students to travel to other cities for clerkships?

The goal of 3rd year clerkships is to have a broad exposure to many different specialties and to prepare for 4th year. Unfortunately, many times you have to decide on your 4th year schedule before you have completed even half of your 3rd year clerkships or really have any idea of what type of specialty you think you want to pursue. At many schools there are no electives at all during the 3rd year, so people are preparing an application for residency without ever having done a rotation in the specialty of interest.

Fourth year takes a wide variety of forms from school to school. My school had four required clerkships, four electives and 3 months of vacation. (There was also one month of elective 3rd year). Most people plan rotations in their specialty of interest early in 4th year. If your medical school has a residency program in that specialty, you rotate at your home school in order to obtain letters of recommendation in support of your residency application. Many people then do 1 or 2 additional rotations in that specialty at other places that have residency programs. These are called “audition” rotations and you typically try to rotate somewhere you have a strong interest in doing residency. You can also obtain letters from these rotations. If your medical school does not have a residency program in your specialty, it is pretty much mandatory to do an away rotation. Vacation months and “light” elective months are used to prepare your residency application, take Step 2, and travel to residency interviews.

It’s pretty complicated . . . most 3rd and 4th year medical students don’t really have a good grasp of how things work until they start planning for them (with their school’s help).

Here’s my 3rd/4th year schedule to give you an example:

3rd year:

1st 8 week block- surgery (general surgery/thoracic surgery)

2nd block: OB/gyn 6.5 weeks, 1.5 weeks of clinical skills

3rd block: one month research, one month family medicine

4th block: psychiatry/neuro

5th block: pediatrics (inpatient ID/inpatient renal/rheum/endocrine)

6th block: internal medicine (one month general internal medicine, one month cardiology)

Fourth year:

July: Emergency Medicine (a required clerkship at my school)

August: vacation (Step 2 and residency application)

September: Internal medicine outpatient (required clerkship)

October: Surgical Intensive Care Sub-internship (elective)

November: Trauma Surgery Sub-Internship (fulfilled a requirement)

December/January: vacation

February: Geriatrics (fulfilled a 4th year requirement)

March: Radiology (elective)

April/May: vacation

I had two extra months of vacation because I did two year long electives: Advanced Topics in Emergency Medicine and Honors Ultrasound. Both of those electives required the same amount of hours over the course of the year as a regular month-long elective. Both of them had 2-3 meetings a month as well as a variety of requirements to fulfill throughout the year.

Hope this helps.

as stated above, 3rd year tends to be at specific locations. Since my school has its own hospital system affiliate all of the 3rd year and the core 4th year rotations are done at home base. However, with electives you can do them anywhere, even international.

When it comes to residencies, you want to schedule early rotations in 4th year where you would like to apply and use them as “auditions”.

When you apply for residency it is like applying for medical school with a central application and waiting for interviews plus, another personal statement. Then in january/february you will rank your programs in order of preference. Finally wait to see if you match. Feb for Osteo and March for allo.

I will also answer your question, even though the other poster already have… only because Wayne attracts a number of students from Toronto.

Wayne used to have 3rd year were you would do different hospitals… now you are stuck pretty much at just one. However, there are several academic and community hospitals to choose from. There is a lottery in picking which hospital you would like to work at for your 3rd year.

Some of the smaller hospitals have some of the rotations at other places. Almost every hospital does their peds at Children’s of Michigan (part of the Detroit Medical Center complex). Some others like the VA have more of their rotations at different hospitals than others.

Then 4th year we will be able to pick which programs from the various hospitals we would like to do. Thus, this allows to get a wider range of experiences than just the campuses we were exposed to in our 3rd year. And as always, electives can be done away.

  • Yerivf Said:
And as always, electives can be done away.


How many "away" rotations does your program allow you to do in MS-4 year? We're limited to 2.

Lots of good information above. To answer your question (and sum up from above), it varies greatly depending on your school. At some schools nearly every clerkship is done at the same hospital or hospital system, at others you may be jumping around amongst hospitals (however, I think at these types of schools, few to some of the hospitals where you rotate will actually have residency programs.)

With respect to doing away rotations in your fourth year, there is a lot of debate whether they are a good idea or not. I believe nearly all schools will allow you to do at least a couple, and most often people will use these to do rotations in their chosen specialty should they choose to do them at all.

As hard as you try to understand 3rd and 4th year, I’m not sure you’ll have a full understanding until you get there. :smiley: Each school has a very unique way to how they approach it.

  • MD2B2010 Said:
As hard as you try to understand 3rd and 4th year, I'm not sure you'll have a full understanding until you get there. :-D Each school has a very unique way to how they approach it.

Thank you to everyone who provided input. I think that MD2B summed up where I have netted out after puzzling through this for the past month or so. I'll just go with it as it unfolds before me.


Looks like we can take all of our electives away… as long as they are approved.

Here’s the link to the info I am basing this on: http://www.med.wayne.edu/student_affairs/recor ds_registration/electives /guidelines.asp